Autonomic Nervous System Changes in Pediatric Patients with Epilepsy on Antiseizure Medications: A Literature Review
Abstract number :
1.422
Submission category :
7. Anti-seizure Medications / 7D. Drug Side Effects
Year :
2024
Submission ID :
833
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Stephanie Dailey, BA – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Fatemeh Mohammad Alizadeh Chafjiri, MD – Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Saeid Sadeghian, MD – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Adriana Ulate-Campos, MD – National Children's Hospital, Costa Rica
Tobias Loddenkemper, MD – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Rationale: Despite antiseizure medication (ASM) availability and effectiveness, about one-third of epilepsy patients taking them continue to have seizures.1 In these patients, accurate seizure prediction may reduce seizure unpredictability and improve quality of life.2 Neurophysiological autonomic nervous system (ANS) tracings may be used in seizure prediction and offer information on medication effectiveness.2 However, the impact of ASMs on the ANS and thus seizure prediction is understudied. This review evaluates the literature on the effects of ASMs on the ANS in pediatric patients with epilepsy, which may also help determine seizure susceptibility.
Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Analyses (PRISMA) guidelines. Using the terms “antiseizure medication or antiepileptic drug”, “epilepsy”, “autonomic nervous system”, and “pediatric population” solely or with “OR” and “AND” functions, we searched PubMed, Web of Science, and Embase for all papers published until June 2023. These papers investigated the ASM impact on ANS aspects, including heart rate (HR), heart rate variability (HRV), temperature (TEMP), and sweat in patients 1 month to 21 years old. Using Covidence software (Melbourne, Australia), two reviewers independently reviewed all titles and abstracts against the inclusion and exclusion criteria (Fig. 1). A third reviewer made the final determination in case of disagreement. The data were extracted from the full text by three reviewers.
Results: After screening 8,853 articles, 15 studies were eligible (Fig. 1). Patients taking zonisamide or topiramate had reduced sweating and increased body TEMP in four studies. In one study, patients on multiple ASMs had significantly decreased high-frequency HRV values, and patients on valproic acid had significantly decreased low-frequency HRV values than those on phenobarbital. One study reported affected ventricle functioning in patients on ASMs. One study reported lower time and frequency domain values of HRV in drug-resistant patients with epilepsy compared to controls. Higher ASM doses lowered HRV but not HR or electrodermal activity compared to lower ASM doses in one study. Either no significant difference or mention of the specific ASM impact on ANS components was found in seven studies (Fig. 2).
Conclusions:
Heart rate, sweat, and temperature assessment show changes in patients with epilepsy taking ASMs. However, many of the included studies focused on general ANS changes with less attention to specific findings in the setting of ASMs. Better knowledge of how ASMs impact the ANS is needed to understand medication effectiveness and side effects and to investigate ASMs as a confounder in seizure prediction.
1. Guery D, Rheims S. Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies. Neuropsychiatr Dis Treat. 2021;17:2229-2242.
2. Ulate-Campos A, Coughlin F, Gaínza-Lein M, et al. Automated seizure detection systems and their effectiveness for each type of seizure. Seizure. 2016;40:88-101.
Funding: The Epilepsy Research Fund supported this study.
Anti-seizure Medications